Volume 3 Issue 1, January 2007

Taking into account the danger of provoking osmotic demyelination by causing an overly rapid rise in the plasma sodium level, these authors from the University of Toronto offer their recommendations for correcting chronic hyponatremia. They highlight the importance of avoiding a substantial water diuresis, and discuss three key clinical settings where such a diuresis can occur.

One in five patients with diabetic kidney dysfunction is anemic. Low hemoglobin levels in this population are associated with an increased risk of progression to end-stage renal disease, increased cardiovascular morbidity and mortality, hypertension, retinopathy, neuropathy and foot ulcers. Here, Merlin Thomas from the Baker Medical Research Institute in Melbourne explores the pathophysiology of anemia in diabetic kidney disease, and the clinical utility of its correction.

A new source of organs became available following the first successful transplantation of a kidney from a living donor half a century ago. Since then, expanding the living donor pool has been a priority. This appraisal of strategies used to increase the number of living kidney donors focuses on transplantation across ABO and HLA barriers, and extending selection criteria to include elderly and obese donors, and those with hypertension.

Experimental data support a role for aldosterone in renal injury that is independent of renin and angiotensin II, and indicate that blocking the activity of this mineralocorticoid might ameliorate progression of chronic kidney disease. Lucia Del Vecchio and colleagues discuss these findings. The authors also review preliminary clinical trial data, which are consistent with a significant antiproteinuric effect of aldosterone antagonists such as spironolactone.